The Bristol Royal Infirmary inquiry has heard evidence of a 'vacuum in relation to the enforcement of standards relating to paediatric cardiac services'.

Dr Michael Godman, president of the British Paediatric Cardiac Association, told the inquiry that during the period under examination 'there was no mechanism, really, for assessing whether or not high quality work was being done.'

The inquiry is examining the deaths of babies who had complex heart surgery at the hospital in the 1980s and early 1990s, when such surgery was based in recognised 'supra-regional' centres.

Dr Godman told the inquiry that funding for such centres was 'essentially about numbers and not about outcomes'.

But he argued that the Bristol centre had always carried out fewer operations than other centres, and 'it would be unlikely that they could have produced as good results as larger centres'.

He said that in the 1980s, various bodies had made recommendations on quality 'but these were not followed through'. He added that there was still a 'vacuum in relation to the enforcement of standards', because royal colleges were concerned with training while the Department of Health and commissioners had failed to set 'clearly defined standards by which centres can be judged'.